Ray Kausik Part 2, PCSK9 Effect On HDL Goal Levels

In part 2 of this Exclusive Interview, Dr. Ray Kausik talks with Diabetes in Control Publisher Steve Freed during the ADA 2017 convention in San Diego, CA about the impact of PCSK9 inhibitor on cholesterol.

Ray Kausik, MB, ChB, MD, is Professor of Public Health in the Department of Public Health and Primary Care at Imperial College London as well as Honorary Consultant Cardiologist at the Imperial College NHS Trust.

Transcript of this video segment:

Freed: Can you give us the highlights of your presentation? And the way I would ask that question is that you’re talking in front of 100,000 PCPs, pharmacists, nurses, dietitians, etc. What do you want them to take home?

Kausik: So, the first thing is in the patient with type 2 diabetes, looking at LDL target is probably the wrong thing to do because there is another lipid target called non-HDL that captures all of the other atherogenic particles in the cholesterol in them. And the beauty of that is, you don’t have to look at in the fasting state; it’s very simple to calculate. It’s total cholesterol minus HDL cholesterol. And you will see in the diabetic patients that that is often quite high in contrast to the LDL cholesterol. So, if that is high, in these people you’ve got to ask yourself the question, how do I lower it further because as triglycerides go up, you find it harder and harder to get the non-HDL to target. And the non-HDL target is about 30 mgs per deciliter higher than the LDL target. So, you’ve got to think about some sort of add-on therapy and once you’ve maximized the statin, what else might you do? The data that we are going to share is around what a PCSK9 inhibitor can do in that situation. In people with high triglycerides whose non-HDL levels are high and not at goal, what’s the role of PCSK9 inhibition there? And what you will see from some of the data that we’ve already shown before this meeting (and I can’t reveal the embargoed data until Sunday), what we have seen in some other post hoc analyses is that actually if you give a PCSK9 inhibitor, you bring non-HDL down really quite remarkably and you can get these people to goal. Because with statin alone, and even with the addition of Ezetimibe, you couldn’t get these people to goal. The thought is that these people’s cardiovascular risk will therefore come down as well.